Healthcare Provider Details

I. General information

NPI: 1144232992
Provider Name (Legal Business Name): PETER JAMES DOLL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 8TH ST
HENDERSON KY
42420-2927
US

IV. Provider business mailing address

323 8TH ST
HENDERSON KY
42420-2927
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-2548
  • Fax: 270-827-4557
Mailing address:
  • Phone: 270-827-2548
  • Fax: 270-827-4557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000639A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00183
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: